Alleged Inappropriate Physical Examinations Conducted by Rheumatologist

This case study explores a breach of standard care in an outpatient clinic setting, where a rheumatologist allegedly conducted inappropriate physical examinations on an adult patient.

ByWendy Ketner, M.D.

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Published on February 13, 2024

Empty examination room

Case Overview

This case study delves into the experiences of an adult patient who was under the care of a rheumatologist in an outpatient clinic setting. The patient reported multiple instances where the physician allegedly conducted inappropriate physical examinations, which involved unnecessary removal of clothing.

In one particular instance, the physician claimed that a stretch exam was required, positioning the patient facing the wall and pinning them between himself and the wall. This case seeks expert insight into outpatient clinic administration, focusing on standard care protocols, patient safety measures, and appropriate staff training.

Questions to the Nursing expert and their responses

Q1

Please describe your experience as an administrator of an outpatient clinic setting.

Over my professional journey spanning three decades, I have served as a Registered Nurse (RN) for 30 years and as a Nurse Practitioner (NP) for 25 years. My administrative roles in two different primary care clinic settings have provided me with extensive experience in managing outpatient clinics.

Q2

What pertinent policies and protocols should be followed to ensure patient safety, including during physical exams?

As both a clinician and administrator, it is paramount to adhere to certain protocols for ensuring patient safety. Patients should only be asked to expose the part of their body being examined.

For example, if we're evaluating a knee condition, shorts would suffice; full undressing is neither necessary nor appropriate. In specialties like orthopedics or rheumatology, specific joints are evaluated but apart from the knee or hip, there's typically no requirement for a patient to undress.

Also noteworthy is that in my 30 years of practice, I've never encountered something called a 'stretch exam'. When it comes to patient safety and staff training, any procedure or examination involving removal of clothing or invasive procedures such as rectal or pelvic exams necessitates a chaperone. This is to ensure the safety of both the patient and the provider.

About the expert

This expert has an extensive background in nursing, with over two decades of experience specializing as a nurse practitioner in family medicine, primary care, and emergency room settings. They have held various roles including being the founding primary care nurse practitioner at a major health service, an assistant professor of nursing at a renowned university, and an administrator at a healthcare operation center. Currently, they serve as a family nurse practitioner at two healthcare services, demonstrating their ongoing commitment to patient care and medical excellence.

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About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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